Furthermore, it is well known that electronic cigarette users do not inhale more deeply than smokers. While smoke does enter the distal airways - which is why adenocarcinoma rates have increased so dramatically - vaping involves aerosol inhalation and the aerosol is mostly absorbed in the upper, not the lower airways. As with a nicotine inhaler, most of the nicotine absorption occurs in the upper airways.

I had intended to blog about your recent paper, but decided instead to write an open letter and to put these concerns to you directly. So, I write to express dismay at the false, misleading and damaging conclusions you have drawn from your recent paper in JAMA Pediatrics and related media communications. The errors of reasoning are elementary, but have been used to draw conclusions that are relentlessly hostile to e-cigarettes and the important public health concept of ‘tobacco harm reduction’.

In banning the sale of e-cigarettes to minors, the legislation defines e-cigarettes the way they should be defined: as vapor products or alternative nicotine products.

Lisa Middleton

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